Shengqiang Qian

Role of Tramadol in Premature Ejaculation: A Systematic Review and Meta-Analysis

Objective: This systematic review was performed to evaluate the efficacy and safety of tramadol in patients with premature ejaculation (PE). Methods: A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared the effects of tramadol with placebo or no drug for patients with PE. The outcomes included post-therapeutic intravaginal ejaculation latency time (IELT), increases in IELT, satisfaction with sexual intercourse, control over ejaculation and side effects (SEs). The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. Results: A total of 5 trials, involving 715 patients, met the inclusion criteria. The synthesized data from these RCTs indicated that compared with the control, tramadol significantly increased IELT values post-therapeutically (SMD 3.51, 95% CI 2.14-4.88, p < 0.00001) and changes in IELT values were more pronounced in the tramadol group (SMD 2.87, 95% CI 2.63-3.10, p < 0.00001). Satisfaction with sexual intercourse and the ability to control ejaculation were both improved in patients in the tramadol group (p < 0.05). The incidence of SEs in the tramadol group were significantly higher than in the control group (RR 3.55, 95% CI 1.34-9.40, p = 0.01), however most SEs were mild or moderate and transient. Conclusions: Tramadol may be effective in PE treatment, especially when patients have failed therapies, like selective serotonin reuptake inhibitors. However, the possibility of drug addiction and SEs should still be considered before initial use or after chronic use of this agent. More high-quality (clear randomization sequences, allocation concealment and blinding introduction), long-term, RCTs with a large number of PE patients are expected.

Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction

Clinical studies evaluating the effectiveness and safety of phosphodiesterase type 5 inhibitors (PDE5is) for female sexual dysfunction have reported conflicting results.

Cryosurgery would be An Effective Option for Clinically Localized Prostate Cancer: A Meta-analysis and Systematic Review

Cryosurgery (CS) has been used on patients with clinically localized PCa for more than 10 years. However, clinical studies evaluating its effectiveness and safety have reported conflicting results. This systematic assessment was performed to obtain comprehensive evidence regarding the potential benefits and safety of CS compared with those of radiotherapy (RT) and radical prostatectomy (RP), respectively. All controlled trials comparing CS with RT or RP and single-arm studies reporting results of CS therapy were identified through comprehensive searches of PubMed, the Cochrane Library and Embase. Ten publications from seven trials, with totally 1252 patients, were included in the meta-analysis, which revealed no significant differences in comparisons of CS vs RT and CS vs RP for overall survival and disease specific survival. However, a significantly lower disease-free survival could be observed for CS than RP. Moreover, a systematic review of literature focusing on comparative data of databases and materials of single-arm trials revealed satisfactory survival results in both primary and salvage CS. Our results showed that cryosurgery would be a relatively effective method for clinically localized prostate cancer with survival results comparable to radiotherapy and radical prostatectomy. However, the large percentage of complications caused by cryosurgery should be carefully monitored.

Phosphodiesterase-5 Inhibitors Could Be Efficacious in the Treatment of Erectile Dysfunction after Radiotherapy for Prostate Cancer: A Systematic Review and Meta-Analysis

Objective: This systematic review was performed to evaluate the efficacy and safety of phosphodiesterase-5 inhibitors (PDE5i) in the treatment of erectile dysfunction (ED) after radiotherapy for prostate cancer (PCa). Methods: A systematic search of PubMed, Embase and the Cochrane Library was performed to identify all randomized controlled trials (RCTs). All relevant studies on the outcomes and complications of PDE5i in the treatment of ED after radiotherapy for PCa were assessed. The outcomes and complications analyzed for this study included the International Index of Erectile Function (IIEF) questionnaire, Global Efficacy Questions (GEQs), Sexual Encounter Profile (SEP) diary and side effects. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis of the outcomes and complications. Results: A total of 4 RCTs were identified from the search strategy. Compared with placebo, the trials indicated that PDE5i significantly improved the IIEF scores, with the exception of two questions (questions 6 and 13), and statistically significantly more positive answers for the GEQs and SEP diary were acquired in intervention groups. Furthermore, almost all the side effects in both groups were mild or moderate, transient and well tolerated. Except for headache, flushing and dyspepsia, all other adverse events did not differ significantly between the two groups. Conclusions: The systematic review suggested significant advantages in the efficacy and safety of PDE5i in the treatment of ED after radiotherapy for PCa. PDE5i should be considered as the first choice for the treatment of PCa patients with ED after radiotherapy.

A meta-analysis of extracorporeal shock wave therapy for Peyronie’s disease

The efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie’s disease (PD) has been controversial for a very long time. We aimed to evaluate the efficiency of ESWT for PD and provide possible evidence on the basis of a meta-analysis of existing comparative studies. All controlled studies, including randomized controlled trials (RCTs), cohort studies and case-control studies, that focused on the efficiency of ESWT for PD, were prospectively identified through comprehensive searches of PubMed, the Cochrane Library and Embase databases. We conducted a meta-analysis of these studies. Six studies including 443 patients were selected for the meta-analysis. Pooling data of these studies showed that ESWT could significantly increase the percentage of men with lessening of penile plaques (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.11–3.85, P=0.02), relief of pain (OR 4.46, 95% CI 2.29–8.68, P<0.0001) and complete remission of pain (OR 5.86, 95% CI 2.66–12.92, P<0.0001). However, insignificant differences were found in improvement of penile curvature (OR 1.88, 95% CI 0.97–3.65, P=0.06) and sexual function (OR 2.22, 95% CI 0.69–7.11, P=0.18) between ESWT and placebo groups. Further, similar results were shown for sensitivity and publication bias analysis when only RCTs were included. However, sporadic complications caused by ESWT were reported, but no patient needed additional treatment aside from conservative observation. ESWT may be an effective and safe treatment for lessening of penile plaques and relieving pain for men with PD, but not for improving of penile curvature and sexual function.

Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence

Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function. [1] Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED) in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy (NPWT). However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO 2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO 2 measurements in different parts of the penis, should be performed.

Advantages and limitations of sleep-related erection and rigidity monitoring: a review

Over the past decades, sleep-related erection and rigidity monitoring has been used to differentiate psychogenic from organic erectile dysfunction (ED), due to the involuntary nature of erections in sleep. This study retrospectively reviewed all available literature focusing on sleep-related erection and rigidity monitoring through a systematic PubMed search. To date, there are mainly seven methods and their modifications, including: sleep laboratory testing, the mercury strain gauge, the stamp test, the erectometer, the Snap gauge, the RigiScan, and nocturnal electrobioimpedance volumetric assessment. This study analyzes and summarizes the advantages and limitations of seven monitoring methods. This study indicates that both of the above methods possess the capacity to assess erectile quality and provide guidance to the diagnosis, etiology, and differential diagnosis of ED. However, some limitations still exist for the application. New devices which can continuously monitor kinds of variables, including sleep-related erection, axial and radial rigidity, and oxygen saturation are needed.

Diagnosis and Treatment of Adrenal Medullary Hyperplasia: Experience from 12 Cases

Objective. To dissect the characteristics of adrenal medullary hyperplasia (AMH) and share our experience of diagnosis and treatment of AMH. Methods. From 1999 to 2013, 12 cases of AMH have been pathologically diagnosed after operation in our hospital. The clinical characteristics, process of diagnosis, treatment, and prognosis during follow-up of all patients are summarized retrospectively. Results. Four cases were trended to be AMH and 6 cases were trended to be pheochromocytoma before operation; moreover, the other two patients were diagnosed accidentally. All patients, except for the patient with mucinous tubular and spindle cell carcinoma of left kidney by open surgery, experienced a smooth laparoscopic adrenalectomy, including 2 with radical nephrectomy, 10 of which experienced unilateral adrenalectomy, 1 was bilaterally partial adrenalectomy, and the remaining one was unilaterally complete removal and then 2/3 partially contralateral excision. After a medium follow-up of 6.5 years, it demonstrated a satisfactory outcome of 8 cured patients and 4 symptomatic improved patients. Conclusions. AMH presents a mimicking morphology and clinical manifestation with pheochromocytoma. Surgery could be the only effective choice for the treatment of AMH and showed a preferable prognosis after a quite long follow-up.

Treat penile Mondor's disease with corticosteroid cream

Thrombophlebitis is a thrombosis disease, which used to appear in the superficial veins in the thoracic wall. It is mostly called Mondor’s disease (MD) in honor of Henri Mondor who first described its clinical feature in 1939 [1]. Braun-Falco described thrombosis in penile veins in 1955 and Helm and Hodge secondly reported it and located it in the penile superficial dorsal vein in 1958 [2]. In previous literature, different treatments for penile MD, from watchful waiting to surgery excision, can be found without consensus since it is a rare condition and only a series of single center cases were reported [2]. In our urologic clinic, we successfully cured a patient with typical MD on his penis using corticosteroid cream. A 31 years old male complained an asymptomatic rope-like induration in the left dorsal area of the penis, and denied penile trauma, vigorous sexual activity or surgery history. In addition, he is free from lower urinary tract symptom and thrombosis disease. Doppler ultrasonography showed a dilated incompressible subcutaneous vein without blood flow in the left dorsa of penis, which confirmed the diagnosis of superficial thrombophlebitis (Fig. 1). The Color Doppler examination confirmed the absence of flow within the left dorsal vein, but normal in right (not show). The

AB131. A meta-analysis of extracorporeal shock wave therapy for Peyronie’s disease.

Objective The efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie’s disease (PD) has been controversial for a very long time. We aim to evaluate the efficiency of ESWT for PD and provide possible evidences on the basis of a meta-analysis of existing comparative studies. Methods All controlled studies, including randomized controlled trials (RCT), cohort studies (CS) and case-control studies (CCS), which focused on exploring the efficiency of ESWT for PD, were prospectively identified through comprehensively searches of PubMed, the Cochrane Library and Embase. Following, a meta-analysis of these studies were carried out. Results Collectively, six studies, including 3 RCT (level of evidence: 1b), 1 CS (level of evidence: 2b) and 2 CCS (level of evidence: 3b), were selected for meta-analysis, in which 443 patients were included. Pooling data of these studies showed that ESWT could significantly improve the percentage of males with lessening of penile plaques [odds ratio (OR) 2.07, 95% confidence interval (CI), 1.11-3.85, P=0.02], relief of pain (OR 4.46, 95% CI, 2.29-8.68, P<0.0001) and complete remission of pain (OR 5.86, 95% CI, 2.66-12.92, P<0.0001). Though insignificant differences were presented in improvement of penile curvature (OR 1.88, 95% CI, 0.97-3.65, P=0.06) and improving sexual function (OR 2.22, 95% CI, 0.69-7.11, P=0.18), there were evident tendencies of favoring ESWT. Further, similar results were shown for sensitivity and publication bias analysis after excluding all CS and CSS. Though sporadic complications caused by ESWT were reported, there was no special treatment were needed, except observation. Conclusions ESWT could be an effective and safe treatment for males with PD. However, more high-quality, well-designed RCT are required to definitely solve this controversy and complete our meta-analysis.